MEDICARE: MARLEY J REALING MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	19702A	WY
2	390200000X	Student in an Organized Health Care Education/Training Program		TN

General Provider Information

NPI Number	:	1831881549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLEY J REALING MD

Provider Business Mailing Address
First Line	:	2510 E 15TH ST STE 12
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82609-4111
Country	:	US
Telephone Number	:	307-333-6910
Fax Number	:

Provider Business Practice Location Address
First Line	:	2510 E 15TH ST STE 12
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82609-4111
Country	:	US
Telephone Number	:	307-333-6910
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2023
Last Update Date	:	06/07/2026

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Directions to “ MARLEY J REALING MD” Practice Location

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